Provider Demographics
NPI:1326264151
Name:HANSELL, PHILLIP LEWIS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:LEWIS
Last Name:HANSELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5948
Mailing Address - Country:US
Mailing Address - Phone:610-740-0336
Mailing Address - Fax:
Practice Address - Street 1:4607 OAKWOOD LN
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-8535
Practice Address - Country:US
Practice Address - Phone:610-837-4683
Practice Address - Fax:610-837-4975
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001764L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical